A doctor too many IV

At the end of 2008, Malaysia has about 23000 doctors, almost half in private sector.

Our Ministry is trying to achieve a ratio of 1:400 as existed in most OECD countries.

In the haste to achieve this number game, they have forgone quality.

It does not mean the more the better. Look at some of the communist countries like Bulgaria. They have a ratio of 1:200 doctor:population ratio. That does not mean that they have a better healthcare than Britain which has a ratio of 1:450. Another example is Kazakhstan which has a ration of 1:280 , as compared to Australia which has a ratio of 1:400.  Does that means that Kazakhstan has better healthcare than Australia?

Our officials stress too much on achieving numbers. They stress too much on ‘form’ rather than substance.

If we have well trained doctor which are productive, a ratio of 1:1100, will mean that we are on par with those 1;400 countries with doctors which have low productivity.

Alas, we built 5 star hospitals with lobby bigger than Shangri La, but you dont need 5 star bed to treat diseases. You need clinical acumen , experience, and doctors who communicate with their patients.

As for the question asked by MKO in the last post (A doctor too many 3), it is still ok to get treatment from govt hospital NOW. In 5 to 10 years time, I am not sure. Unless they buck up, and set up a body to oversee the standard of doctors produced, I will not want to get treatment there in 10 years time.

I must stress that I am never against producing doctors. I am not in favour of producing too many INADEQUATELY TRAINED doctors. That would be like producing too many gun-carrying policemen without training them as to when to shoot and when not to shoot.

At the rate we are producing doctors, 4000 a year, we will soon be down to 1:100 ratio.

Let us assume that we have a population of 27 million. Let us assume that the population growth is 3%. So every year, we have an additional 800000 people. Divide 800000 by 400, you get 2000. That means once we achieve a ratio of 1:400, we need only to produce 2000 doctors a year to maintain the ratio found in most advanced country. But we will be producing 4000 local plus 1000 from overseas (India, Indonesia etc..many will be staying put in the place they study like my children). So there will be excess 3000 doctors a year… This will quickly bring our ratio down to perhaps 1:100, and you will find some of the hawkers and taxi drivers with MBBS degree hanging in their stalls or taxis.

Not joking…

And looking at the history of medicine at advanced countries, when their doctor:population ratio decreased, the charges went up, and so was the cost of medical treatment , even when taken into consideration of inflation. This is because those who are competent, will charge higher and do more investigations, to make up for the decrease in number of patients each doctor is seeing.

There will come a stage when we have too many doctors, too many lawyers(already happening since some junior lawyers have to pay the senior lawyers to do their chambering), too many nurses, too many hawkers, too many cars, too many motorcycles, too many politicians, too many parties, too many police, too many criminals and too many crooks….. I dread to think of such a day!

As for the suggestion by Stevent in the last post, yes, we can send them overseas to work and gain experience, but which country would take them in if their standard is low? I am sure there is a cutting point where even Singapore would not want to take them in, as is the case now.

So you can still send them, to tag with experience doctors. That would like starting their medical training again and you need to pay overseas doctors money to do that sort of things, and there is really no guarantee these people will come back, once they are competent enough to be able to find a working job overseas.

The whole system is rotten, and all the planners can think of is short term and they are all very short sighted… Ultimately they will  suffer too if there is a drop in medical standard. Because health hits everyone equally, it does not mean that if you are wealthy and powerful, you would not get cancer or immune disorders.. Ultimately, like facing the creator, everyone will have to face health problems, and they will then realise that what a monster they have created in their haste to achieve certain figures… Because a healthcare system without good doctors will be like a monster released ..


19 Comments (+add yours?)

  1. sgdr
    May 06, 2010 @ 11:42:58

    Dear Dr Hsu,
    I proposed a win win situation for Malaysia and Singaopore.

    Malaysia can send their junior doctors to work in Singapore and acquire their postgraduate training here.
    These doctors can then return to Malaysia in the future.

    This way, we can ease manpower shortage in Singapore and ensure quality postgraduate training for Malaysian junior doctors.

    Interested junior doctors can send their applications to:

    Human Resources & Talent
    Development Division
    MOH Holdings Pte Ltd
    1 Maritime Square
    #11-25 HarbourFront Centre
    Singapore 099253

    Fax : (65) 6720 0980
    Email : physician@mohh.com.sg



  2. Dr Hsu
    May 06, 2010 @ 11:54:39

    I doubt they will come back once they have acquired their necessary good training… Are you from Singapore MOH? IOf so, it is real efficient of you. 🙂


  3. CYC
    May 06, 2010 @ 12:02:09

    Our electorate continue to vote BN is simply a clown act by itself. And the story continues………… all things rotten except the Brahmin class of politicians still enjoying the perks and ill gotten wealth. Other stupid peasant and low class workers will chucked into the rubbish dump once over live their usefulness of tax paying capability.


  4. klm
    May 06, 2010 @ 12:12:40


    I have children of friends and family members already under training in Singapore. A few have even been sent by MOH to Canada for further training. They are pampered in Singapore.

    I doubt they will ever return to work in Malaysia. In Malaysia, they will be treated as second class.


  5. A true Malaysian
    May 06, 2010 @ 15:28:30

    Dr. Hsu,

    Do you think MOH of Malaysia read your articles here like what sgdr so efficiently did?

    I wonder if they do read, so what? Your thoughts and ideas, to right-thinking people, are good and practical but I am so sure to them.

    Even politician doctors like Dr. CSL and Dr. NYY are not so concern about health care, maybe they don’t regard themselves as doctor anymore.

    If PM Najib adopts your views and ideas, he doesn’t need to instruct Umno politicians to mix more with the Chinese. Really sad over all these politicians.


  6. A true Malaysian
    May 06, 2010 @ 15:46:27

    sgdr is right to say Malaysia and Singapore can work together for mutual benefit, but I doubt those in Umno are willing to do that due to their ‘big brother’ mentality. They rather jump down from the Petronas Twin Towers than to cooperate with Singapore. To them, they lose face if they work with Singapore.

    I really hope when PR is in power, such ‘big brother’ mentality will not be there. What PR should do is the overhaul the whole system, get back on track and get rid of third world mentality amongst its people. There are so huge potential amongst Malaysians and natural resources that we can tap expertise from Singapore and other countries to work on these potentials.

    Well, we have said enough but things are not getting better ….. all due to ‘big brother’ mentality.



  7. Dr Hsu
    May 06, 2010 @ 16:15:20

    To think that UMNo politicians can gain chinese votes by going direct to the chinese community is naive.

    If UMNO does not change, and the present policies remain, whatever these politicians do will not change the views of the majority of the chinese, especially the urban ones.

    As an analogy, if a robber who goes into your house and have done bad things to your family, would you want to befriend him even if he suddenly gives you some sweets to eat?

    I do not understand why they cannot see this point and keep on their extremist posturing.


  8. A true Malaysian
    May 06, 2010 @ 16:45:32

    For Umno to treat Malaysia or Tanah Melayu as the motherland for the Malays elsewhere (Singapore inclusive), they are damned wrong.

    Such kind of thought maybe applicable to older generation like what our forefathers to China, to the new generation of both Malaysia and Singapore, we have no such emotional link anymore.

    In fact, many Singapore Malays look down on their cousins in Malaysia. So, I can’t understand why the ‘big brother’ mentality here.

    It is this ‘big brother’ mentality that causes in Umno refuses to change. They rather ‘look nice’ outside but no substance inside.

    That’s why, Dr. Hsu, “they cannot see this point and keep on their extremist posturing.” You can still ask this question but not your comrades in Gelakan and BN. If not, MCA and Gelakan would have long out of BN. 😀


  9. SE
    May 06, 2010 @ 21:01:44

    what if a doc doesn’t have a primary medical degree recognized by Singapore MOH, but has a recognized PG qualification? e.g MD(Russia), MRCP(UK)?is there any chance?


  10. sgdr
    May 06, 2010 @ 22:30:18


    Yup MRCP is registrable:)

    Pls send in your application form to

    Human Resources & Talent
    Development Division
    MOH Holdings Pte Ltd
    1 Maritime Square
    #11-25 HarbourFront Centre
    Singapore 099253

    Fax : (65) 6720 0980
    Email : physician@mohh.com.sg



  11. tehjiao
    May 06, 2010 @ 23:37:52

    Dr Hsu,
    I strongly agree that the quality of the new doctors are down to the drain recntly, my colleagues and I do encounter a lot of new HO who don’t even know “Aspirin = Antiplatelet” , “Human have “12”Cranial Nerves” which is the BASIC of the medical knowledge in Medical Year 1 syllabus. I’m worried that our health care quality will definitely deteriorate VERY SOON in next 5 years. However, I don’t see any one including our MOH DG forsee this. To make the things worse, recently there is Pekeliling to order HO to RATE their HOD/Consultant/Specialist/ Medical officer whether they treat them “nice or not” but ignore about the HO’s knowledge and attitude problem. I’m not sure that the idea of staying in MOH is a good idea in near future as I can forsee that there will be a lot of BIG PROBLEMS in our health care service soon as these incapable HO will become incapable MO and may even be accepted and trained as specialist by local Master programs. To avoid all these mess, I rather opt for working oversea…..


  12. Dr Hsu
    May 07, 2010 @ 12:10:31

    I have heard many stories about these too.. They do not even hv the basic knowledge and yet they are passed and pampered as housemen..

    This is the beginning of giving crutches to new medical graduates, and once they have these crutches, how are they going to learn anything?

    And many of them will just be passed as registrars and given Post graduate MMed from local universities, and they will be specialists treating you and me..



  13. klm
    May 07, 2010 @ 12:26:46

    Dr. Hsu.

    1. If you as a doctor is scared, what about me?
    I cannot tell the difference between a surgeon and a butcher.

    2. On another thought, maybe we can let these half past six HOs loose on the medical tourists and immigrant workers. Let them practice on these people.



  14. IMR
    May 07, 2010 @ 14:43:34


    Hi all, I am a medical recruitment consultant with IMR.
    Please kindly visit our website if anyone is interested to work in Australia or New Zealand.

    We welcome Malaysians especially those who have studied in UK, Australia and New Zealand to apply.


  15. Dr Hsu
    May 07, 2010 @ 15:49:28

    Thanks IMR.. Looks like my website is becoming the recruitment centre for Malaysian doctors to work overseas..

    Even medscape.com, the biggest doctors’ website internationally, has posted my “A doctor too many” in their forum, under the title “doctor mill in Malaysia’…


  16. tehjiao
    May 07, 2010 @ 16:49:56

    Dr Hsu,
    Can u post the link of Medscape forum? HAve Google it but can’t find the forum. tq


  17. klm
    May 07, 2010 @ 17:10:48

    Dr. Hsu Well done! Malaysia can now be a hub for medical education. We can beat Indonesia or Russia soon. Good for the national purse.


  18. Dr Hsu
    May 07, 2010 @ 22:02:57

    u need to register with medscape.com, and they will update you with the latest medical advances, ONly thing theya re quite strict and they require u to scan your registration and degree to register as a member. It is mainly a website for keeping up with medical advances and the latest findings and continued medical education.

    the url is http://www.medscape.com


  19. A true Malaysian
    May 20, 2010 @ 18:47:33

    Dr. Hsu,

    You are far ahead of your comrade Dr. Teng Hock Nam.

    Gelakan finally adopts your idea. Better late than never?



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